Tear Trough Rejuvenation

 Bags, dark shadows, and circles can cause even the most well rested person to look tired. Creams and cucumbers are good for treating texture and puffiness but often they do not go far enough.

The real issue may be loss of skin elasticity (skin sagging) and fat accumulation that causes depressions that run from the nose and around the under eye area. A common nonsurgical fix to this problem is the use of a hyaluronic acid dermal filler, like Juvederm.  Juvederm is injected above the bone of the eye socket and gently massaged into the pocket beneath the eye to fill in any hollows and make the eyes appear more rested.

 The procedure is quick with minimal pain, most injections take less than 30 minutes. 

 The results are instant and can last up to twelve months. 

Common side effects are mild bruising and swelling. Avoid taking blood thinning medications (aspirin, ibuprofen), supplements (fish oil, garlic), or beverages (alcohol, excessive caffeine)
for 3 days before the procedure.

More Detailed Information on Dermal Fillers

Did you want to know more in depth details on the history of injectable fillers and how they work? Check this out! 

Hyaluronic Acid

Hyaluronic acid is the most prominent glycosaminoglycan in the skin. Hyaluronic acid potently binds to water and, when injected into the skin, volumizes, softens, and hydrates the skin. In addition to these benefits, it plays a role in cell growth, membrane receptor function, and adhesion.

Hyaluronic acid stabilizes intercellular structures and produces the viscoelastic network for collagen and elastin fibers to bind together. As seen with photoaging, these connections fail, thus resulting in disorganized clumps of collagen and elastin. These benefits make hyaluronic acid an excellent dermal filling agent.

Because hyaluronic acid is identical in all species, the risk of allergy is remote. Hyaluronic acid has a heparinlike effect, thus resulting in a greater incidence of bruising than is seen with collagen fillers. Until 2010, nearly every FDA-approved hyaluronic acid product in the United States did not contain lidocaine, thus significantly increasing the discomfort experienced with injection of these dermal fillers compared with the bovine- and human-derived collagen fillers. Despite these shortcomings, hyaluronic acid fillers still emerged as the leader of dermal filling agents for soft tissue augmentation, owing to their superior cosmetic results.

In the uncommon circumstance when an undesirable outcome occurs with hyaluronic acid, correction is possible with the injection of commercially available hyaluronidase, which breaks down the unwanted hyaluronic acid dermal filler. The use of hyaluronidase for this purpose is not FDA approved and is considered an off-label use. In many cases, 10-30 units of unpreserved hyaluronidase is sufficient to achieve the desired correction. Local site reactions may occur in up to 25% of persons, although they are typically transient and mild. Initial treatment with as little as 5-10 units is commonly recommended and is often effective, although some treat with as much as 75 units with few adverse effects. Additional corrections can be performed, although full correction may take up to 4 weeks to fully appreciate. Some preparations are bovine derived, and skin testing should be considered prior to treatment with these dermal fillers.

Hyaluronidase preparations are clear, concentrated liquids that are stored in a refrigerated vial. To reconstitute these dermal fillers, physicians typically add normal saline or lidocaine (with or without epinephrine). When using Amphadase, reconstitution using 3 mL of 1% lidocaine with 1:100,000 epinephrine has been commonly used with great success. After mixing, the vial is gently swirled. Prior to treatment, a skin test can be performed by injecting 3-5 units (0.06-0.1 mL) of the reconstituted solution into the superficial dermis at the antecubital fossa. A positive hypersensitivity reaction consists of a wheal appearing within 5 minutes and lasting 20-30 minutes, accompanied by local itching.

Juvederm (Juvederm Ultra/Juvederm Ultra Plus)

In 2006, the FDA approved Juvederm, which is also a nonanimal stabilized hyaluronic dermal filler. In the United States, only 2 types of Juvederm dermal fillers are FDA approved. Both Juvederm Ultra and Juvederm Ultra Plus contain 24 mg/mL of hyaluronic acid, but Juvederm Ultra Plus has a higher proportion of cross-linking than Juvederm Ultra. Juvederm is a homologous gel with the highest degree of cross-linking of any of the hyaluronic acid fillers and thus has a smooth consistency. In 2010, both Juvederm Ultra and Juvederm Ultra Plus became available with lidocaine, to reduce pain with injection, both labeled as Juvederm (R).

Table 5. Juvederm Dermal Fillers (Open Table in a new window)

Agent	Contents	Method of Action	Indications	Injection	Duration	Limits
Juvederm Ultra	Sterile, biodegradable, nonpyrogenic, viscoelastic, clear, colorless homogenized gel implant; cross-linked hyaluronic acid formulated to a concentration of 24 mg/mL suspended in a physiological buffer; hyaluronic acid is produced byStreptococcus equi bacteria	Adds natural volume as it integrates into dermal tissue; then, attracts and binds water molecules to help maintain volume	Depressed scars Facial contour enhancement, including lips Dermal atrophy from disease or corticosteroid injections Wrinkles, creases, and lines caused by facial expression or aging	One box contains 2 prefilled syringes, each containing 0.8 mL of hyaluronic acid; inject into mid dermis	Approximately 6-12 months	20 mL/60 kg (130 lb) body mass per year
Juvederm Ultra Plus	24 mg/mL of hyaluronic acid (same as above) but with a higher proportion (11%) of cross-linked hyaluronic acid	Same as above	Same as above	Same as above. Injected into mid-to-deep dermis	Approximately 9-12 months	20 mL/60 kg (130 lb) body mass per year

Calcium Hydroxylapatite

This novel filler, Radiesse, was FDA approved in December 2006 for the correction of facial wrinkles and folds and for the correction of HIV-associated facial atrophy. In 2009, it received FDA approval for cosmetic use in non-HIV patients as well. The dermal filler is composed of 30% calcium hydroxylapatite and 70% carrier gel. The clinical results may last as long as 12 months or longer, although the carrier gel lasts no longer than 6 months, thus often resulting in a slight decrease in correction at that time.

Radiesse is nearly always injected subdermally at the dermal-subcutaneous junction; thus, this product is not a true dermal filler. Studies from 2008 suggest that calcium hydroxylapatite may induce neocollagenesis, although further research is needed.

Because of the pain associated with injection, some practitioners add lidocaine to the syringe, without a clinical appreciable decrease in effect. Mariano Busso, MD, has treated numerous patients by adding 1 drop of 10% lidocaine to the previously available 1.3-mL syringe of Radiesse to decrease the discomfort associated with injection. Treatment of the hands has been accomplished with the addition of 0.15-0.23 mL of 2% lidocaine per 1.3-mL syringe of Radiesse. This can be accomplished using a nose-to-nose (female-to-female) Leur-lok connector to connect the syringe of Radiesse to a 3-mL syringe containing the lidocaine. At least 10 passes of the product back and forth between the 2 syringes is recommended to achieve adequate and even distribution of the lidocaine. This makes the consistency of the Radiesse slightly thinner, thus making it easier to spread when using a bolus injection technique. Similarly, this mixture is often preferred for the treatment of the temples.

In 2010, Radiesse was released, which contains lidocaine to reduce pain upon injection.

Belotero

Belotero: “The New Wrinkle Killer”

When it comes to treating fine lines and wrinkles, a specially formulated skin smoothing agent is necessary to erase the first signs of aging. Belotero is the newest dermal filler to provide patients with a weapon to finally effectively combat wrinkles, a filler that New York Cosmetic Dermatologist Dr. Cameron Rokhsar, M.D., says is the newest tool to tackle upper lip lines and fine lines around the eyes.

Belotero targets specific concerns where fine lines can form, most commonly on the upper lip and around the eyes,” Dr. Rokhsar says. “It can also be injected more superficially compared to other hyaluronic acid fillers, giving it a unique precision.

New York, New York (PRWEB) March 05, 2013

A new wrinkle eraser has recently been released onto the market called Belotero, a dermal filler that shows rival potential against other longer-standing fillers. Belotero is a gel that has been demonstrating exceptional results in significantly diminishing upper lip lines and fine lines around the eyes. These lines are one of the first few signs of aging and can be filled in so precisely and accurately with Belotero, it’s as if wrinkles are airbrushed right off the face, leaving behind a smooth surface. This new filler can provide reassurance for those that want to get rid of fine line wrinkles, allowing them to achieve their cosmetic goals and delay signs of aging.

Because of its ability to seamlessly integrate with the skin’s natural facial features, Belotero provides a detailing effect by providing subtle volume to the face as well as hydrating the skin. Patients who have lost their once youthful lips and eyes to wrinkles can have them restored with the injections that provide safe and effective results. During conversation, lips and eyes receive the most focus and attention, which is even more of a reason to keep them free from fine lines. The skin changes after years of facial expressions, sun damage and exposure to various substances, it’s only natural that the aging process show itself eventually, but that doesn’t mean the wear and tear left from years of experiences have to remain. Modern medicine advances rapidly, resulting in the constant expanding and improving of treatments to fulfill consumer demands. This provides patients with tailored treatments based on their personal cosmetic goals.

There are several dermal fillers available today and each has its own distinct properties. These fillers are primarily used to fill in and smooth out superficial to deep wrinkles, as well as augment, enhance and improve the volume of certain facial features. Radiesse is a calcium based filler used to augment nose, cheekbone and chin features. Another filler injection used to prevent the effects of aging is Sculptra, which is primarily composed of poly-L-lactic acid, a naturally occurring substance that works by restoring collagen into the deeper layers of the skin. Overtime Sculptra will stimulate collagen production that will allow for a gradual and natural skin enhancement. Collagen is a key protein responsible for keeping the skin tight and smooth and has the ability to partially reverse the aging process if stimulated.

The newest filler injection to provide patients with a smooth correcting tool is Belotero. Belotero is a hyaluronic acid based filler much like Restylane, Perlane, and Juvederm. These dermal fillers differ in the way their molecules are cross linked, granting each one a unique strength that makes some better at treating certain wrinkles and augmentations than others. Belotero is thinner and more lightweight compared to its predecessors, giving it the ability to naturally restore the fine lines formed from laughing, smoking and squinting, among many other repetitive micro-muscular movements.

“Belotero targets specific concerns where fine lines can form, most commonly on the upper lip and around the eyes,” Dr. Rokhsar says. “It can also be injected more superficially compared to other hyaluronic acid fillers, giving it a unique precision.”

Before Belotero was made available, superficial injections of other hyaluronic acid fillers could create the Tyndall effect. This occurs when light passes through a clear substance, giving skin an undesirable blue discolored appearance. Belotero is specifically designed and proven to effectively treat fine lines so patients no longer have to settle for another filler.

Hyaluronic acid is naturally present in the body. It is found most highly concentrated in the eyes and joints and acts as a cushion and hydrating mechanism. As a natural complex sugar that attaches itself to water, hyaluronic acid has the ability to absorb more than one-thousand times its own weight. Because hyaluonic acid is naturally produced in the body, Belotero eliminates the possibility of the body rejecting the filler so no allergy tests are required. Belotero was created using a technology called a Cohesive Polydensified Matrix which makes the final injection produce a solution with a high degree of elasticity. The combination of hyaluronic acid, collagen and elastin provides a powerful structure within the skin. This directly results in a rehydrating appearance while providing an evenness and enhancement in facial contours.

Dr. Cameron K. Rokhsar, M.D., is the leading authority in laser surgery and non-invasive techniques, Dr. Rokhsar, has extensive training and expertise in the field of skin tightening and wrinkle reduction. A graduate of Harvard and New York University, Dr. Rokhsar is a fellowship-trained dermatologist and laser surgeon and extensively published medical author and Professor of Dermatology at Albert Einstein College of Medicine. His offices are located in New York City and Garden City, Long Island.

Which Dermal Filler is Right for You?

Dermal Fillers

Medical aesthetic professionals use many anti-aging skin care techniques to correct eye wrinkles and other signs of natural aging. One non-surgical method that has become extremely popular is the use of dermal fillers. Dermal fillers you may have heard of include hyaluronic acid fillers. 

Medical aesthetic professionals refer to the use of dermal fillers as soft tissue augmentation. Soft tissue augmentation is a cosmetic procedure performed to correct eye wrinkles, other facial wrinkles, depressions in the skin and/or scarring. The procedure involves injecting a substance such as hyaluronic acid or collagen into the area being treated to plump it up or fill it up. With very few exceptions, the result is not usually permanent and touch-up injections may be required every three to 12 months depending on which substance was injected and your specific body chemistry.

We give you a brief overview of each dermal filler, but you should consult with your medical aesthetic professional about which one may be right for you.

Dermal Fillers - How They Work & What They Do

Dermal fillers work by plumping up the area around the injection site. Different fillers do this in different ways, but the ultimate result is that the skin around the injection site looks fuller giving your face a more youthful appearance. A basic over view of the skin and its function will help you to understand this better.

Our skin consists of 2 layers: the epidermis and the dermis. The uppermost layer, the epidermis, serves as a protective layer. It controls the loss of water from the cells and tissue and serves as a barrier to the external environment. Just below the epidermis is the dermis. The dermis contains the structural elements of the skin such as blood vessels, nerves and hair follicles. Protein forms a network of fibers that provide a framework for the growth of cells and blood vessels. Because it’s the primary component of the dermis, collagen acts as a support for the skin, giving the skin its strength and elasticity.

Over time, aging thins the upper layer of skin, the epidermis, decreasing its ability to serve as a barrier to retain water. Additionally, the body’s production of collagen slows and the existing collagen becomes less effective. Thinning epidermis and decreased collagen effectiveness lead to eye wrinkles and other signs of aging. All dermal filers act as anti-aging products by reducing the effects of thinning epidermis and less-effective natural collagen.

What Do Dermal Fillers Treat?

Hyaluronic acid and other dermal fillers are some of the most effective anti-aging treatments available. In general, dermal fillers return volume and fullness to the face, eliminating overt signs of aging and imparting a more youthful appearance. Dermal fillers are a non-surgical way to achieve the following outcomes:

• Plump thin lips
• Enhance shallow contours (such as the the nasolabial folds)
• Soften facial wrinkles and creases
• Improve the appearance of recessed scars

Hyaluronic Acid Dermal Fillers 

Hyaluronic acid is a naturally present component of connective tissue whose function is to cushion and lubricate. Hyaluronic acid helps the body to lock moisture in the dermis which results in a more youthful appearance. The hyaluronic acid molecules lock in moisture because they bind many times their weight in water. Both natural and injected hyaluronic acid will degrade in your body over time. Hyaluronic acid injections help to achieve a fuller look for approximately six months.

Hyaluronic acid is not a new product. In addition to being used for aesthetic purposes, hyaluronic acid has been used for more than 20 years to help improve arthritic joints as well as for eye surgery and wound repair. Its long term effects have been well tested and documented.

There is a very low potential for allergic reaction because hyaluronic acid is a natural substance that exists in the human body.

Juvederm^®

Juvederm^® is a brand of facial filler that is hyaluronic acid based. As your skin matures, the amount of hyaluronic acid found in the skin naturally decreases which in turn causes that skin to become less hydrated. This leads to facial wrinkles and folds.

Juvederm^® is a smooth consistent gel. Although the FDA has approved the use of Juvederm^® to fill in moderate creases around the mouth, it is also commonly used for softening the appearance of scars and other depressed marks on the face. It can also be injected around the eye to lessen the appearance of dark circles. Its effects last from 6 to 12 months. There are no animal proteins in this product and, therefore, there is very little chance of an allergic reaction. As with other dermal fillers, Juvederm’s side effects tend to be mild. They can include temporary site redness, swelling, tenderness, firmness, lumps and bruising lasting seven days or less.

Here at Beauty Redefined we offer two different types of Juvederm, Juvederm Ultra Plus (which is an 0.8ml syringe and is whipped 30% more than Restalyne so it goes in smoother with less chance of lumping), and Juvederm Ultra Plus XC (which is a 1.0ml syringe, has a little bit of lidocaine in it so it doesn't get as sore when injecting, and is whipped 30% more than Restalyne as well). 

Radiesse^®

Radiesse^® is another form of dermal filler used for soft tissue augmentation. It is composed of beads of Calcium Hydroxylapatite (CaHA) suspended in a water-based gel carrier. Radiesse works by stimulating the body into producing more collagen. It gives the skin an overall smooth appearance by adding volume to the face and is a great substance for getting rid of deep, etched-in lines around the cheek and the nasolabial folds. The result is immediate and tends to last 12 to 15 months

Radiesse^® is injected into the treated area by a fine gauge needle. Radiesse does not contain lidocaine, a natural anesthetic, as some dermal fillers do. It is necessary to use a topical and/or a local anesthetic with Radiesse^® injections.

The use of Radiesse^® is approved by the FDA to help eliminate nasolabial folds (the “parenthesis” fold around the mouth). Radiesse^® is not advised for the lips. The pressure from the muscles in the lips can cause the filler to form lumps.

Voluma

JUVÉDERM VOLUMA™ XC injectable gel is a smooth, colorless hyaluronic acid (HA) gel that contains a small quantity of local anesthetic (lidocaine). HA is a naturally 

occurring sugar found in the human body. The role of HA in the skin is to deliver nutrients and help the skin retain its natural moisture and softness. The addition of lidocaine helps to improve the comfort of the injection. JUVÉDERM VOLUMA™ XC injectable gel is manufactured using VYCROSS™ technology to give a specialized smooth-gel filler that produces long-lasting results at the treatment site. JUVÉDERM VOLUMA™ XC is delivered by an injection into the cheek and surrounding area of the mid-face to correct volume and fullness.

What is it for?

JUVÉDERM VOLUMA™ XC is indicated for deep (subcutaneous and/or supraperiosteal) injection for cheek augmentation to correct age-related volume deficit in the mid-face in adults over the age of 21. 

What does it do?

As you age, the cheek area loses its youthful shape. The cheeks flatten out and the skin may begin to sag. JUVÉDERM VOLUMA™ XC injectable gel is designed to temporarily reverse these signs of aging. It is a gel that is injected into the cheek area to lift the skin. It temporarily adds volume to the cheek area and results in a smoother contour and more youthful appearance to the face. 

Belotero

BELOTERO BALANCE^® Dermal Filler is an injectable filler that quickly integrates into your skin.¹ Once injected, it instantly smoothes the lines and wrinkles in your face.While BELOTERO BALANCE^® Dermal Filler is made of the same material (hyaluronic acid) as some other dermal fillers, BELOTERO BALANCE^® Dermal Filler has unique properties that allow it to adapt within the skin for soft and even correction. The versatility of the product makes it strong enough to handle deep treatment areas such as nasolabial folds (smile lines around the mouth), yet soft enough to treat more delicate areas such as vertical lip lines  (thin lines that appear above the lip line).